Organization
EASTER SEALS MAINE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY GAMMON (PRESIDENT & CEO)
(603) 623-8863
Entity
Organization
Contact information
Practice address
555 AUBURN ST, MANCHESTER, NH 03103-4803
(603) 623-8863
Mailing address
555 AUBURN ST, MANCHESTER, NH 03103-4803
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0921635002
CIGNA
ME
01
—
1341145
AETNA
ME
05
—
191720000
—
ME
05
—
191720001
—
ME
05
—
191720100
—
ME
05
—
191720200
—
ME
01
—
AA16930
HARVARD PILGRIM HEALTHCARE
ME
Enumeration date
10/05/2010
Last updated
03/15/2018
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